Disability as a Public Health Issue

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Disability as a Public Health Issue

• Glen W. White, Ph.D.
• University of Kansas

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(No Transcript)
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APHA and Disability Awareness
From Chicago to San Francisco
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Public Health and Disability

• Public health has traditionally been primary
  prevention oriented (e.g., immunizations, vehicle
  safety belts).
• Those who develop disease or injuries (e.g.,
  polio, SCI) often fall through the cracks.
• Today we have 54 million Americans with
  disabilities -- 54 million--oopses!

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Significance of the Problem

• Medical technology and advances have increased
  rates of survivors with severe trauma or chronic
  conditions.
• Survivors face long rehabilitation, yet health
  care system capitation forces compressed
  treatment and recovery time.
• Public health can provide a positive contribution
  in the health of people with disabilities as they
  move from medical settings into community living.

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Significance of the Problem

• As of 9/30/03 there were over 267,000 adults with
  disabilities living in nursing homes across the
  US who want to live more independently in the
  community.
• Source www.cms.hhs.gov/states/mdsreports/res2.asp

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Significance of the Problem

• Over 70 of adults with disabilities are
  unemployed, compared to the typical unemployment
  rate for non-disabled persons of 6.
• Source N.O.D./Harris Survey of Americans with
  Disabilities, 2000 US Dept of Labor Bureau of
  Labor Statistics October, 2003.

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• HP 2010 Leading health indicators
• Physical Activity 
• Overweight and Obesity 
• Tobacco Use 
• Substance Abuse 
• Responsible Sexual Behavior 
• Mental Health 
• Injury and Violence 
• Environmental Quality 
• Immunization 
• Access to Health Care 

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• HP 2010 Leading health indicators
• Physical Activity 
• Overweight and Obesity 
• Tobacco Use 
• Substance Abuse 
• Responsible Sexual Behavior 
• Mental Health 
• Injury and Violence 
• Environmental Quality 
• Immunization 
• Access to Health Care 

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Reported by VA Campbell, PhD, JE Crews, DPA, L
Sinclair, MPH, Div of Human Development and
Disability, National Center on Birth Defects and
Developmental Disabilities, MMWR, September 13,
2002.
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Getting Back to Work

• Ticket to Work and Work Incentives Improvement
  Act of 1999 (TWWIIA).
• Gives people with disabilities resources to
  return to work, or improve their existing work
  situation (i.e., part time to full time).

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Getting Back to Work

• TWWIIA ticket tracker
• As of 11/03/2003 over 5,626,633 Tickets to Work
  have been issues to people with disabilities
  across 34 states.
• Only 3,168 have used them with employment
  networks.

Source http//www.ssa.gov/work/Ticket/ticket_info
.html
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Attacking the Problems

• Public Health Research
• Public Health Practice
• Public Health Education

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Public Health Research

• People with disabilities have at greater health
  risks for health problems than those without
  disabilities.
• People with disabilities often have greater
  health disparities compared to non-disabled
  populations.
• CDC and other federal agencies are placing more
  attention on research to help increase positive
  health outcomes for the 54 million Americans with
  disabilities.

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Public Health Research

• More research needs to address both person and
  environment factors and their relationships to
  health outcomes.
• Important progress is being made in the
  measurement of the environment and disability.

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Public Health Research

• The IOM report, Enabling America noted that the
  majority of federally funded disability research
  is focused on person factors (e.g., cure).
• Little public funding is being spent on
  environmental risk and protective factors that
  affect health outcomes for people with existing
  disabilities.
• CDC is one notable exception.

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Public Health Science

• Important milestones
• Healthy People 2010 Chapter 6
• 13 health objectives dealing specifically with
  people with disabilities and their health
  disparities.
• The cornerstone of this chapter is objective one
  whose outcome is that disability status be
  included as a demographic variable in all
  health-related surveys.

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Public Health Science

• Important milestones
• International Classification of Functioning (ICF)
• The ICF is the public health complement to ICD.
  ICD classifies etiology to frame case definitions
  for primary prevention.
• ICF classifies human functioning for improved
  public health science and policy.
• ICF also allows classification and coding of
  environmental factors affecting human function.

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Public Health Practice

• There needs to be better translation and
  technology transfer from the scientist to the
  PH practitionerto improve specified public
  health outcomes.
• Living Well With a Disability
• Research needs to be both rigorous and relevant.

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Public Health Practice

• All public health programs need to acknowledge
  the at-risk status of people with disabilities.
• This can be achieved by including people with
  disabilities in the planning and implementation
  of the 10 essential public health services.
• Like other minorities, people with disabilities
  bring a unique expertise to framing and
  implementing public health activities.

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Disaster Planning and Disability

• Among those people with disabilities employed
  full or part time, 50 say no plans have been
  made to safely evacuate their workplace.
• 58 of people with disabilities do not know whom
  to contact about emergency plans in their
  community.
• A public health collaboration to address disaster
  planning and emergency response for people with
  disabilities is currently under way in 30
  national FEMA declared disaster counties.

NOD/Harris Poll, November 2001
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Public Health Education

• More needs to be done to address the topic of
  disability and health in overall public health
  training curricula.
• Universal approach where disability and health
  is woven in to all curricula.
• Targeted approach where specific disability and
  health courses are taught in schools of PH.

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Public Health Education

• Schools of Public Health should affirmatively
  recruit and retain qualified students with
  disabilities into their programs.
• Schools of Public Health should establish working
  relationships with disability organizations as
  possible sites for student practica or
  internships.

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TAKE HOME MESSAGES

• Increase visibility of people with disabilities
  in public health.
• Increase the full participation of people with
  disabilities in public health activities.
• Reduce health disparities among people with
  disabilities.

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To leave footprints in the sands of time you
must wear work shoes.
Old African Proverb